Epicardial adipose tissue radiomics predicts VR and MACE after AMI: a prospective cohort study

Epicardial adipose tissue (EAT) has been implicated in adverse cardiac remodeling after acute myocardial infarction (AMI), but its imaging-based characterization remains limited. This study was designed to develop and validate EAT radiomics-based models for predicting ventricular remodeling (VR) and major adverse cardiovascular events (MACE).

A single-center prospective cohort study enrolled 206 AMI patients at the Second Affiliated Hospital of Anhui Medical University between January 2022 and June 2023. EAT radiomics features were extracted from cardiac CT using Pyradiomics, and predictive models were constructed with machine learning algorithms. Statistical analyses were performed using R, Python, and SPSS, with significance set at P < 0.05.

During 12-month follow-up, 29.6% developed VR and 19.9% experienced MACE. EAT volume was independently associated with both outcomes (P < 0.001). Radiomics-based Model 2 showed superior predictive performance compared with Model 1, with higher AUC and C-index values across validation folds. Experimental studies demonstrated that EAT aggravated myocardial injury, fibrosis, and apoptosis, which were partially attenuated by IL-6 neutralization.

Integrating EAT radiomics with clinical parameters improves prediction of VR and MACE after AMI and is supported by experimental evidence linking EAT to post-infarction remodeling.